Caitlin Cawley was only 15 when she developed tendinitis in both elbows. The condition is commonly known as “tennis elbow,” but Cawley wasn’t practicing her serve. She was studying classical percussion at a pre-college program for aspiring musicians.

She ignored the early signs until the prickling sensation grew to stabbing pain throughout her forearms so excruciating she had to stop playing. It took three months of rest for the inflammation in her tendons to subside, and she has had multiple flareups since then.​Now 21 and a senior at Boston University’s School of Music, Cawley is preparing to audition for graduate programs. So while most college applicants can breathe a sigh of relief now that their Jan. 1 deadline has passed, she and other music students are headed back to the practice rooms. Cawley currently averages six hours of independent practice a day, not including ensemble rehearsals. In her words: “Right now I’m doing as much work as I’ve ever done for music.”

Boston University senior Caitlin Cawley practices on the marimba. (Ian Coss for WBUR)

That diligence also means risk of injury. For Cawley and other young musicians, the question of this season is: How much practice can my body take before perfection turns to pain?

Their odds are not good. In the mid-2000s, a Chicago-based physician began surveying the incoming music students at a midwestern university, and after four years, the trend in the data was clear: Almost 80 percent of freshman “reported a history of playing-related pain.”

For players of string, keyboard and brass instruments the percentage was even higher. For percussionists like Cawley: 100 percent.

He describes the crux of the problem: “If you look at a string quartet, it’s the most natural looking sight, but if you simply remove the instruments from their hands and pose them on stage, it’s nothing that we were ever really designed to do for any long period of time.”

The arms are elevated, wrist extended, head tilted — all while performing rapid repetitive motions (a two-minute movement from Handel’s “Messiah” includes 740 strokes of the violin bow). It’s a recipe for repetitive stress injuries, and the same could be said of any instrument when played intensively.High-pressure events such as auditions and recitals bring heightened risk, Charness says; they push musicians to put in eight or 10 hours a day and repeat the same passage over and over to get it right — “things that most athletes know not to do.” He often sees those same musicians in his clinic once the pressure has passed.

Performing PatientsEvery Saturday, there is a line of musicians at the Brigham and Women’s clinic carrying instrument cases of all shapes and sizes. Dan Snydacker, a harpsichordist who travels from Connecticut for treatment, describes the waiting area as tense — somber even: “We all share this sense of potential loss.”About half of the musicians that Charness sees suffer from overuse injuries to the soft tissue, such as tendinitis. The doctor watches each one play, looking for tension in the shoulders or an unnecessary twist in the wrist — subtle habits that can lead to strain.Slightly less common are nerve injuries — often in the wrist and elbow, where nerves can become compressed or entrapped in the joints. In many cases the condition is totally painless, only affecting the musician’s coordination.The most rare and debilitating musical malady is focal dystonia, a neurological condition that is rooted in the brain but impacts a specific part of the body — fingers for pianists and sometimes the lips for players of wind instruments. The condition is not well understood even though it affects almost 2 percent of professional musicians — including the celebrated pianist Leon Fleisher and possibly the 19th century composer Robert Schumann.Snydacker, the harpsichordist, knew something was wrong when he started missing notes on the keyboard. Then he noticed that his fingers were curling under his palm involuntarily when he tried to play. The dystonia was interfering with the motor routines he had developed over years of playing, and he now receives regular botox injections that relax the overactive muscles in his hand. Total recovery is unlikely; Snydacker is just hoping that he can still play the harpsichord for his grandchildren.Read the entire article at commonwealth.wbur.org

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